EMSA Revising Patient Statements to Help Resolve Confusion
May 06-- EMSA is changing statements it sends to patients to indicate they are a member of a city utility program and do not owe the charges in most cases.
The agency is also in talks with area hospitals about how to share insurance information and discussing ways the city of Tulsa can standardize addresses of multifamily properties.
EMSA's actions come after months of criticism from patients and elected officials about confusing billings, lawsuits filed in error and other problems related to the TotalCare program.
"I think that, yes, there was some confusion and that this would be a much easier way to communicate with the patients," EMSA CEO Steve Williamson told the Tulsa World.
Williamson said EMSA hopes to have the statements in place by July 1. EMSA signed a contract with a company to print the new billing forms last year, he said. The company has been working on changes to clarify TotalCare membership for several months, he said.
The Emergency Medical Services Authority is a government agency that supervises a contractor providing ambulance service to more than 1.1 million people statewide. In Tulsa, Oklahoma City and surrounding cities, residents pay a monthly fee -- $3.64 in Tulsa -- to receive emergency ambulance service.
A World review of lawsuits filed by EMSA in Tulsa District Court found 124 people who lived at addresses that city records showed were included in a monthly utility program. Of the 124 people sued who were in the program, 108 lived in Tulsa and 16 lived in area cities, including seven defendants in Bixby and Jenks, where citizens cannot opt out of the utility program. The 124 defendants were named in 97 lawsuits filed since Jan. 1, 2009.
EMSA claims of those cases, about half involved addresses that EMSA records show had either opted out on the date of service or could not be located in EMSA's database. The remainder of the patients did not contact EMSA after repeated attempts to obtain insurance information or received insurance payments but did not send them to EMSA as required, EMSA claims.
Records show EMSA has dismissed about five lawsuits it filed against patients in Tulsa District Court and given at least 10 refunds to patients who claimed they paid bills they did not owe. In at least one case, EMSA cited "clerical error" in filing a lawsuit against a Jenks woman whose paycheck was garnished.
A committee of EMSA trustees will meet next week to discuss requesting an investigative audit of the agency. The city of Tulsa is also conducting a management review study expected to be complete in June.
EMSA has 118 types of financial statements it sends to patients. None of the statements mention the TotalCare program and state "due from patient" and "due upon receipt."
Under the new program, EMSA will send two types of statements: one to patients whose addresses show to be opted into the TotalCare program and another to patients whose addresses do not match EMSA's data. Once a month, EMSA receives a database of addresses from the city of Tulsa indicating which customers pay the monthly fee and which ones have opted out.
The new statement for TotalCare patients says: "This is not a bill. You are a TotalCare/city utility fee member. We need additional information from you. Please see below." Another spot on the bill states: "do not pay."
"If you have insurance which covers this service, please send complete insurance information to our office and we will be happy to file a claim on your behalf," the statement says.
The program also covers patients without insurance, and the statement asks them to contact EMSA to notify the agency of that information.
The second statement includes a balance and due date and the statement: "If we have missed your participation in our TotalCare/city utility fee program in error, please contact Patient Financial Services immediately to notify us of your status."
Williamson said gathering insurance information is a challenge for EMSA.
"A lot of people don't even respond until they get that third-party mailing from an attorney's office. Some don't even do that until they go to judgment," he said.
City Councilor Blake Ewing said he believes EMSA's decision to redesign its statements "sounds like progress and definitely some steps in the right direction."
Ewing sponsored a resolution urging EMSA to request an investigative audit of its operations.
He said he continues to favor an audit.
"The question isn't just about TotalCare," he said. "All types of practices at EMSA are being questioned. ... They need to be held to a higher standard in terms of their transparency."
In addition to changing the statements, EMSA is also in talks with area hospitals to share insurance information on patients. Williamson said Tulsa City Councilor Karen Gilbert has led the effort.
Gilbert said she has met with officials at St. John Medical Center and hopes to coordinate the effort with all local hospitals. She said the goal is to develop a release form so EMSA can gather insurance information from the hospitals.
"They always have these consent forms patients have to sign," Gilbert said. "Why not just one more consent form stating that the patient gives permission for the hospital to release insurance information to EMSA?"
Williamson said EMSA officials also are working with the city to clarify addresses of patients who live in apartments and other multifamily settings. In many cases, a central office is listed as the address while patients may live at dozens of varying addresses not listed in the database.
"By and large, our biggest challenge is the multifamily residences," he said. "Many of the addresses aren't tied to the central meter for that complex in a logical address order because it might span two or three blocks."
A review of EMSA's billing and collections practices by the city's Management Review Office is expected to be complete at the end of June.
About 80 percent of Tulsa's single-family homes and just over half of the multifamily residents participate in TotalCare, records show. Customers can opt out of the program in June and just began receiving an annual notice about the program in water bills. Before the new statements, customers only learned about the program through the annual notice and information on EMSA's website.
"We are anxious to see if there are any other efficiencies that the management review office would come up with," Williamson said.
Ziva Branstetter 918-581-8306
ziva.branstetter@tulsaworld.com
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